Does lymph node status influence adjuvant therapy decision-making in women 70 years of age or older with clinically node negative hormone receptor positive breast cancer?

Am J Surg. 2017 Dec;214(6):1082-1088. doi: 10.1016/j.amjsurg.2017.07.036. Epub 2017 Sep 18.

Abstract

Background: Women ≥70 years old with clinically (c) lymph node (LN) negative (-), hormone receptor (HR) positive (+) breast cancer are recommended not to be routinely staged with a sentinel LN biopsy. We sought to determine how this affects adjuvant decision-making.

Methods: Statistical analyses were performed to determine the association of LN evaluation with adjuvant chemotherapy and radiation therapy in cLN-, HR + breast cancer patients in the National Cancer Database.

Results: Between 2004 and 2013, there were 193,728 patients aged 70-90 with cLN-, HR + breast cancer; 15.0% were LN+. LN + patients were more likely to receive chemotherapy (28.3% vs. 5.5%, p < 0.001), hormonal therapy (83.6% vs. 71.4%, p < 0.001), post-lumpectomy radiation therapy (81.4% vs. 73.6%, p < 0.001) and post-mastectomy radiation therapy (30.3% vs. 5.1%, p < 0.001).

Conclusion: 15% of patients aged 70-90 will be LN+. These patients more frequently receive systemic and radiation therapy. LN status may affect treatment in these patients.

Keywords: Adjuvant therapy; Axilla; Breast cancer; Elderly; Sentinel node biopsy.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Breast Neoplasms / pathology*
  • Breast Neoplasms / therapy*
  • Chemotherapy, Adjuvant
  • Combined Modality Therapy
  • Decision Making*
  • Female
  • Humans
  • Lymph Node Excision
  • Lymphatic Metastasis / pathology*
  • Mastectomy
  • Mastectomy, Segmental
  • Neoplasm Staging
  • Radiotherapy, Adjuvant
  • Sentinel Lymph Node Biopsy